Minority Health and Health Equity Archive

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Attitudes about Racism, Medical Mistrust, and Satisfaction with Care among African American and White Cardiac Patients
(2000) LaVeist, Thomas A.; Nickerson, Kim J.; Bowie, Janice V.
The authors examine determinants of satisfaction with medical care among 1,784 (781 African American and 1,003 white) cardiac patients. Patient satisfaction was modeled as a function of predisposing factors (gender, age, medical mistrust, and perception of racism) and enabling factors (medical insurance). African Americans reported less satisfaction with care. Although both black and white patients tended not to endorse the existence of racism in the medical care system, African American patients were more likely to perceive racism. African American patients were significantly more likely to report mistrust. Multivariate analysis found that the perception of racism and mistrust of the medical care system led to less satisfaction with care. When perceived racism and medical mistrust were controlled, race was no longer a significant predictor of satisfaction.
A methodological note on modeling the effects of race: the case of psychological distress
(2008) Nuru-Jeter, Amani; Williams, Chyvette T.; LaVeist, Thomas A.
Psychological distress is an important indicator of the mental well-being of the population. Findings regarding racial differences in distress are inconclusive but may represent an important pathway through which disparities exist across a number of physical health outcomes. We used data from the 1994 Minority Health Survey, a nationally representative multiracial/ethnic sample of adults in US households, to examine racial/ethnic differences in psychological distress (n = 3623). Our primary study aim was to examine differences between additive and multiplicative models in assessing the influence of income and gender on the race/distress relationship. We hypothesized that additive models do not suffi ciently account for potential interactions of race with income and gender, and may therefore mask important differences in distress between racial groups. The results suggest that our hypotheses were supported. After adjusting for income, there were no statistically signifi cant differences in distress levels between racial groups. However, significant differences emerge when multiplicative models are used demonstrating the complexities of the intersection of race, income and gender in predicting psychological distress. Black men and women of higher income status represent a particularly vulnerable group, whereas Hispanic men are especially hardy. We discuss the implications of our fi ndings for future work on racial health disparities.
Race and Trust in the Health Care System
(2003) Boulware, L. Ebony; Cooper, Lisa A.; Ratner, Lloyd E.; LaVeist, Thomas A.; Powe, Neil R.
Objective. A legacy of racial discrimination in medical research and the health care system has been linked to a low level of trust in medical research and medical care among African Americans. While racial differences in trust in physicians have been demonstrated, little is known about racial variation in trust of health insurance plans and hospitals. For the present study, the authors analyzed responses to a cross sectional telephone survey to assess the independent relationship of self-reported race (non-Hispanic black or non-Hispanic white) with trust in physicians, hospitals, and health insurance plans. Methods. Respondents ages 18–75 years were asked to rate their level of trust in physicians, health insurance plans, and hospitals. Items from the Medical Mistrust Index were used to assess fear and suspicion of hospitals. Results. Responses were analyzed for 49 (42%) non-Hispanic black and 69 (58%) non-Hispanic white respondents (N=118; 94% of total survey population). A majority of respondents trusted physicians (71%) and hospitals (70%), but fewer trusted their health insurance plans (28%). After adjustment for potential confounders, non-Hispanic black respondents were less likely to trust their physicians than non-Hispanic white respondents (adjusted absolute difference 37%; p=0.01) and more likely to trust their health insurance plans (adjusted absolute difference 28%; p=0.04). The difference in trust of hospitals (adjusted absolute difference 13%) was not statistically significant. Non-Hispanic black respondents were more likely than non-Hispanic white respondents to be concerned about personal privacy and the potential for harmful experimentation in hospitals. Conclusions. Patterns of trust in components of our health care system differ by race. Differences in trust may reflect divergent cultural experiences of blacks and whites as well as differences in expectations for care. Improved understanding of these factors is needed if efforts to enhance patient access to and satisfaction with care are to be effective.

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